Heroin: treating the epidemic

(Editor’s note: This is the second of two articles focusing on heroin use in the area.)

The word “epidemic” is being used in Ohio and here in Preble County to describe the numbers of heroin users and dealers who are in the area.

When it comes to knowing about the treatments available for those who become users, Mental Health and Recovery Board Executive Director Kelli Ott has seen the ups and downs in clients.

One drug Ott has seen used in Preble Conty is Vivitrol, which acts as a blocker and prevents someone who has previously overdosed on heroin, from getting high again. Vivitrol works for 30 days and can be extremely expensive.

Saboxin, a “heroin replacer,” gives users some of the same feelings as heroin, but is not as intense as the opiate.

Methadone, a user could take enough of to get a “buzz,” explained Ott.

Members of the treatment community believe Medication Assisted Treatment (MAT) is the best way to overcome their addiction. However, in-hand with MAT should be counseling.

“Because what the counseling does, then, is teach them how to re-manufacture their lives. How to stay away from the people who are a negative influence on you, how to avoid those cravings and other things you can do when you are craving to stay away from the drug. So the theory is, if you have them on a replacer medication while they are going through those treatment protocols, and they are learning those things to keep themselves clean, then as you start to wean them down, there might be a little bit of a withdrawal, but it shouldn’t be anywhere near what they’d go through if they’d go cold-turkey,” said Ott.

“And they’d hopefully have those skills in place by that point in time to be more successful.”

When an individual is charged with a drug-related crime, the money that they are being fined goes to the city’s “drug fund” to cover the cost of Narcan and other means of enforcing drug-related measures by police.

Attorney General Mike DeWine said recently he has also seen heroin affect the economic side of things as well in that the number of people who are not able to pass a drug test is also increasing, making employment an increasing problem.

“Another anecdotal thing I’ve seen through our agencies… is the educational level of the people coming through the treatment agency, you know, you used to see predominately people that either hadn’t finished high school, yet, or only had a high school education, and now we’re getting people with college educations.. It definitely crosses all economic lines,” said Ott.

An Ohio Substance Abuse Monitoring Network report states, “Participants described typical heroin users as white, with ‘younger’ individuals identified as most likely to use the drug.”

Ott says heroin has resurfaced recently, but has always been an underlying issue. Previously an issue, opiate pills were extremely prevalent approximately six years ago, Ott said there was a strong effort to get unused medications out of individuals’ medicine cabinets and into a safe, contained area.

However, “Many of us on the clinical perspective sat here and said, ‘it’s a great that thing they’re doing, cracking down on those opiate pills, however, unless you address the addiction that is going on with the person using those pills, we’re still going to have a problem, and all of us predicted heroin was going to start to soar, and that’s exactly what happened,” said Ott.

Also on the Mental Health and Recovery Board, Eaton Police Chief Chad DePew said, “We have focused a lot of our attention to what we call ‘Crisis Intervention’ training which is teaching law enforcement to better interact with and handle people who are in a mental health crisis or who are developmentally disabled.”

Also involved with Good Samaritan Behavior Health and Marie Dwyer Recovery Center, the MHRB has taken the initiative with trying to work with local courts on creating a “Drug Abuse Task Force” to shorten the amount of time from the drug arrest to the order to treatment from a judge.

In some cases, someone who has committed a drug-related crime could wait for up to six months until they are introduced into a court-ordered treatment program. The hopes of the organization are to introduce someone to a form of treatment program sooner after their sentence, so they may be faced with treatment options sooner.

“We just decided that we were going to try to see what we could to about trying to turn this tide,” said Ott. Hoping to bring forces together, the Drug Abuse Task Force in Preble County has invited a member from the Montgomery County’s chapter of the Drug Abuse Task Force to share her tactics to best combat the epidemic.

While there is no in-patient facility in Preble County, DePew said that courts in the county have the ability to send addicts to facilities in Dayton or Cincinnati.

When the country was in an economic downturn, Ott explained that she noticed a decrease in individuals searching for help, specifically with the Preble County Mental Health and Recovery Board. Ott attributes this in part to perhaps a decrease in law enforcement, which is normally the binding link between the Recovery Board and their cases, as many people are court-ordered to treatment.

“What we’re doing now isn’t working. Not by a lack of effort. The struggle we have with law enforcement is we can arrest 100 people a day, but if they’re not being held accountable in the courtroom, not having any consequences for their actions, they’re going to be right back out,” said DePew.

Explaining that courtrooms have obstacles in their practices, too, DePew does express his desire to see tighter laws surrounding drug laws. Sheriff Mike Simpson said, “You’re not going be able to arrest your way out of this problem, there’s an enforcement aspect of it, but at the same time if we’ve got people that are addicted to this, then there has to be something through the medical field, to the mental health and recovery, things of that nature, the Marie Dwyers of the world, that can work on this addiction.

“Now, the people have got to want to get off of it. But, I think you’ve got to hit it at an education aspect… if somebody truly wants off and asks for help, there has to be a vehicle that they can get help, and there’s also going to be the enforcement section. If you’re caught with it, there’s a penalty to that,” Simpson said. “Our hope is, that if you arrest them, they’re going to want help, and they’ll go through the programs and they’ll keep themselves clean and stay off of it… we can’t put everyone in prison or jail, that’s not going to work.”

Simpson said enforcement is working together to pool their resources to combat this epidemic. DeWine stressed the importance of the educational elements around heroin and that “every county’s gotta do it their own way.”

To combat the epidemic, DeWine said to be successful it is important to have education/prevention, treatment, and law enforcement and “all three of them have to be working at the same time.”

Recovery housing would be important to people’s rehabilitation, according to Ott, however, “people view substance abuse as a moral failing, and we know, from a scientific stand-point that there is a chemical change that happens in your brain when addiction occurs,” said Ott.

“It is often times more difficult to get help for people for an addiction than it is for something like a mental illness, or a developmental disability. Because, again, it’s just the perspective and the stigma that’s attached to addiction is so much greater.”

The death rate related to drugs in Preble County, according to the Preble County General Health District, was five in the calendar year 2013, however there were nine in 2012, and eight in 2011. These numbers, however, include people who have died within Preble County. It is possible, that someone from Preble County died in Montgomery County due to a drug overdose and vice versa.